Gastrointestinal bleeding can happen anywhere in the gastrointestinal (GI) tract, which runs from the mouth to the anus. GI bleeding isn’t common in people with bleeding disorders like hemophilia. But because it can be serious, you should never ignore possible signs of a GI bleed.

If you or a loved one has hemophilia, it’s safest to assume that abdominal pain or cramps come from a GI bleed until you can rule it out. GI bleeding can also have a different underlying cause, but you’ll need to seek medical care to be certain.

Here are the facts you need to know about GI bleeding if you’re living with a bleeding disorder.

Signs and Symptoms of Gastrointestinal Bleeding

The symptoms of GI bleeding are different depending on where in your gastrointestinal system you’re bleeding.

You might experience bleeding in the:

• Upper GI tract (mouth, esophagus, and stomach)
• Small bowel
• Lower GI tract (large intestine, rectum, and anus)

GI bleeding can also be acute (starting suddenly and possibly severe) or chronic (long-lasting, or coming and going over time). These details can also affect how symptoms appear.

Acute GI Bleeding Symptoms

Acute bleeding in the upper GI tract often causes hematemesis (vomiting of blood), while lower GI tract bleeding typically causes blood in the stool. However, it’s not always easy to tell where bleeding is coming from based on acute GI bleeding symptoms. Some symptoms can indicate bleeding from either the upper or lower GI tract.

Signs of acute gastrointestinal bleeding can include:

• Black, tar-like stool
• Dark or bright red blood in the stool
• Dark brown, grainy vomit
• Bloody vomit
• Abdominal cramps
• Tiredness
• Lightheadedness

A severe acute GI bleed can cause a person to go into shock. Shock is a life-threatening medical emergency and can cause:

• Confusion or a loss of consciousness
• Cold extremities
• Sweating
• A racing heartbeat
• Pale skin

Seek immediate medical care if you or a loved one has symptoms of shock. Tell your doctor about any signs of acute GI bleeding.

Chronic GI Bleeding Symptoms

Chronic GI bleeding can also cause blood to appear in your stool, but it might not be enough blood to be visible. When blood is in the stool but isn’t visible to the eye, it’s called occult bleeding. It can be detected with a stool test.

Symptoms like bloody or tarry stool tend to come and go with chronic GI bleeding. Significant blood loss from chronic GI bleeding can lead to anemia, which causes symptoms like fatigue, pale skin, and trouble breathing.

How Hemophilia Causes Gastrointestinal Bleeding

People with hemophilia are at a higher risk of experiencing GI bleeding than people who don’t have bleeding disorders. With hemophilia, low levels of clotting factors in your blood mean that even tiny injuries can cause a lot of bleeding or that bleeding may occur spontaneously without any obvious injury when the factor levels are too low.

Hemophilia can cause bruising or excessive bleeding from just about anywhere, even with no clear cause. GI bleeding isn’t a typical symptom of hemophilia, unlike nosebleeds and joint bleeds which are common. However, upper GI bleeding can happen in up to 25 percent of people living with hemophilia.

Von Willebrand disease, the most common inherited bleeding disorder, may cause GI bleeding from the rectum because of a condition called angiodysplasia. Angiodysplasia enlarges blood vessels in the stomach and intestine and makes them prone to bleeding. People with von Willebrand disease are more likely than those with other bleeding disorders to have angiodysplasia and associated recurrent GI bleeding.

Risk Factors for GI Bleeding in People With Hemophilia

Some people with hemophilia are more likely to experience GI bleeds than others with the same condition.

A 2024 study found that people with hemophilia A had more GI bleeding episodes than people with hemophilia B. This was true in all racial groups except for non-Hispanic white people. Non-Hispanic white people with hemophilia B were more likely to experience GI bleeding than non-Hispanic white people with hemophilia A.

Taking certain medications, like aspirin, may also increase your risk of GI bleeding with hemophilia. Aspirin further reduces blood clotting, so healthcare providers usually don’t recommend that people with bleeding disorders take it.

Aspirin also damages the inside of your stomach, which can set the stage for GI bleeding in people with hemophilia. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) increase your risk for peptic ulcers and gastritis, which are common causes of upper GI tract bleeding.

Drinking alcohol may also increase your risk of a GI bleed if you have hemophilia. Like aspirin, alcohol irritates the inside of your stomach and can cause bleeding.

Other Possible Causes of Gastrointestinal Bleeding

Keep in mind that your hemophilia might not be the underlying cause of your GI bleed. Other, unrelated conditions may be to blame. However, bleeding disorders can make the bleeding worse than it would otherwise be.

Common Causes of Upper GI Tract Bleeds

Upper GI tract bleeds originate in the esophagus or stomach. They often cause you to vomit blood, which sometimes looks more like coffee grounds than bright red blood.

Upper GI tract bleeds can start with:

• Peptic ulcers — Slow-healing sores in your stomach or duodenum (upper part of the small intestine), commonly due to infection by a bacteria known as Helicobacter pylori
• Gastritis — Inflammation or damage to the stomach lining, often from medications or infections
• Esophagitis — Inflammation and possible ulcers in the esophagus, often from gastroesophageal reflux disease (acid reflux)
• Esophageal tears — Tears in the lower esophagus caused by intense vomiting
• Tumors — Benign or cancerous growths in the stomach or esophagus can cause upper GI bleeding

Common Causes of Small Bowel Bleeds

Bleeding from the small intestine tends to make stools look black and tarry. The most common causes of small bowel bleeds include:

• Small bowel inflammation — Often from Crohn’s disease or NSAID use
• Polyps — Noncancerous growths in the small intestine
• Angiodysplasia

Common Causes of Lower GI Tract Bleeds

Lower GI tract bleeding from the large intestine or rectum can cause bright red blood to appear in stools. Lower GI tract bleeding can come from:

• Cancer or polyps
• Colitis — Inflammation in the colon, often from inflammatory bowel disease (IBD) or infections
• Diverticular disease — Small sacs that push through weak spots in the colon wall with blood vessels that can tear and bleed
• Hemorrhoids — Swollen, bulging blood vessels around the lower rectum or anus

What To Do About Gastrointestinal Bleeding

Call your doctor right away if you have a bleeding disorder and experience any signs of gastrointestinal bleeding. Even if you only have stomach pain, it’s wise to assume you have a GI bleed. Your doctor will explore all possible causes of your symptoms and treat you accordingly.

Taking clotting factor concentrate could help control GI bleeding. Always follow your doctor’s instructions for managing hemophilia or other clotting disorders like von Willebrand disease.

There may be false alarms in some cases. For example, certain medicines can darken your stools and make them appear bloody. Always read the label on medications or supplements to see if they can change the appearance of your stools.

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